title: Surgical management of lower urinary mesh perforation after mid-urethral polypropylene mesh sling: mesh excision, urinary tract reconstruction and concomitant pubovaginal sling with autologous rectus fascia.
abstract: OBJECTIVE
  We present our management of lower urinary tract (LUT) mesh perforation after mid-urethral polypropylene mesh sling using a novel combination of surgical techniques including total or near total mesh excision, urinary tract reconstruction, and concomitant pubovaginal sling with autologous rectus fascia in a single operation.
  
  
  METHODS
  We retrospectively reviewed the medical records of 189 patients undergoing transvaginal removal of polypropylene mesh from the lower urinary tract or vagina. The focus of this study is 21 patients with LUT mesh perforation after mid-urethral polypropylene mesh sling. We excluded patients with LUT mesh perforation from prolapse kits (n = 4) or sutures (n = 11), or mesh that was removed because of isolated vaginal wall exposure without concomitant LUT perforation (n = 164).
  
  
  RESULTS
  Twenty-one patients underwent surgical removal of mesh through a transvaginal approach or combined transvaginal/abdominal approaches. The location of the perforation was the urethra in 14 and the bladder in 7. The mean follow-up was 22 months. There were no major intraoperative complications. All patients had complete resolution of the mesh complication and the primary symptom. Of the patients with urethral perforation, continence was achieved in 10 out of 14 (71.5 %). Of the patients with bladder perforation, continence was achieved in all 7.
  
  
  CONCLUSIONS
  Total or near total removal of lower urinary tract (LUT) mesh perforation after mid-urethral polypropylene mesh sling can completely resolve LUT mesh perforation in a single operation. A concomitant pubovaginal sling can be safely performed in efforts to treat existing SUI or avoid future surgery for SUI.
authors.affiliation: Division of Urology, University of Colorado, Denver, CO, USA.
authors.forename: Ketul
authors.initials: K
authors.lastname: Shah
authors.forename: Dmitriy
authors.initials: D
authors.lastname: Nikolavsky
authors.forename: Daniel
authors.initials: D
authors.lastname: Gilsdorf
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Flynn
mesh_terms: D000007:Abdominal Injuries / Q000209:etiology* / Q000601:surgery; D000328:Adult; D000368:Aged; D020878:Device Removal / Q000009:adverse effects; D005205:Fascia / Q000637:transplantation; D005260:Female; D006801:Humans; D008875:Middle Aged; D017699:Pelvic Pain / Q000209:etiology; D011475:Prosthesis Failure / Q000009:adverse effects; D012086:Reoperation; D012189:Retrospective Studies; D053825:Suburethral Slings / Q000009:adverse effects*; D013526:Surgical Mesh / Q000009:adverse effects*; D014521:Urethra / Q000293:injuries*; D001743:Urinary Bladder / Q000293:injuries*; D014550:Urinary Incontinence, Stress / Q000517:prevention & control / Q000601:surgery; D014552:Urinary Tract Infections / Q000209:etiology; D014621:Vagina / Q000601:surgery